Week 2-Psychiatric history Flashcards

1
Q

What are the 4 components of a psychiatric assessment?

A

1) Psychiatric history
2) mental state examination
3) physical examination
4) risk assessment

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2
Q

What is involved in diagnostic formualtion of a psychiatric patient?

A

1) Description of the patient
2) Differential diagnoses
3) Aetiology
4) Management
5) prognosis

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3
Q

What is the purpose of the psychiatric history?

A

1) Gather information on psychological and physical symptoms
2) Understand the impact of symptoms on the patient’s life
3) Understand the context of the patient’s problems from a psychological and social point of view
4) contributes to risk assessment
5) contributes to formulation
6) provides therapeutic intervention

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4
Q

In what ways is the psychiatric history different to a standard history?

A

Psychiatric history is longer in length and time to complete with a number of sections.

You may not be able to gather all info in one sitting and may need to fill gaps from other sources e.g. collateral and notes

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5
Q

What should you consider when taking a psychiatric history?

A

1) Setting, quite and private
2) Build a rapport and be flexible
3) Time constraints
4) Safety –> alarms, patient not between you and the door, inform colleagues where you are, who you are seeing

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6
Q

What is building a rapport about?

A

Building a rapport is about building trust and a therapeutic relationship

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7
Q

What should you consider when trying to build a rapport?

What are key skills to use here?

A

Treat patients with respect, empathy and sensitivity.

Think about your 1) body language 2) eye contact 3) phrases and language used.

Key skills:

Active listening (e.g. nodding, acknowledgement (yes, okay, reflections, summarising).

Encouragement : tell me more about that

Validation : I appreciate this must be really difficult to talk about

Appropriate use of silence

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8
Q

Why is building a rapport important especially with the psychiatric patient?

A
  • It may be the first time they’ve built the courage to talk to someone
  • They may need reassurance, and have unrealistic beliefs/ unhelpful beliefs of what may happen to them
  • They may have experienced stigma when talking about MH in the past
  • They may feel isolated (the only one to exp. these sx)
  • They are talking about personal and painful feelings/ experiences
  • May be concerned about the impact of discussing sx on work/ relationships
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9
Q

What are the components of an introduction in a psychiatric hx?

A
  • Introduce yourself and explain purpose of the interview
  • Explain how long the assessment is likely to take
  • Explain need to take notes
  • explain any cofidentiality issues
  • Gain the patient’s consent to speak to informants
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10
Q

Describe the structure of the psychiatric history

A
  • Personal details
  • Referral details
  • Hx of presenting complaint
  • past psychiatrix hx
  • past medical and surgical hx
  • drug hx and allergies
  • family hx
  • social hx
  • personal hx
  • substance and alcohol hx
  • forensic hx
  • premorbid personality
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11
Q

What are the key personal details you need in a psychiatric hx?

A
  • Name
  • Age
  • address, type of accomodation
  • occupation
  • marital status
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12
Q

What are key details of referral hx you need in psych hx?

A
  • Record place and time pt seen
  • Voluntary or detained under MHA?
  • source of referral
  • reason for referral
  • informants name and relationship to the patient
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13
Q

What are key details of the presenting complaint?

A
  • Patients own words
  • may be appropriate to record problems as described by the informant
  • Brief description
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14
Q

Key factors in the hx of presenting complaint?

A
  • Can use similar structure to physical sx (SQITARPS/SOCRATES)
  • Site/ Quality –> nature of symptoms
  • Intensity –> impact
  • Timing –> onset, development, duration, frequency, course
  • Precipitating or exacerbating factors
  • Relieving factors
  • Associated sx
  • Explore relationship between psychiatric symptoms, physical symptoms and social problems
  • Current treatment and effect
  • Previous episodes
  • Previous treatment and effect
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15
Q

How would you explore the presenting complaint of a patient hearing voices?

A
  • Onset –> When did they start? Are they there all the time or only certain times? Have they changed since they first began?
  • Site –> are the voices in your head or do you hear them through your ears?
  • Quality/ intensity –>
    • How many voices are there?
    • Are the voices male or female?
    • do you recognise the voice?
    • Do they speak directly to you, about you or give a running commentary?
    • What do they say?
    • do they tell you to do anything? (command hallucinations)
    • do they stop you from doing anything
  • Associated symptoms –> tactile or visual hallucinations, delusions, thought insertion/ withdrawal/ broadcast, feelings or reference, low mood?
  • Relieving factors?
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16
Q

What are the uses of open vs closed questions?

A

Open questions:

Enable patients to describe things in their own words

Helpful for the presenting complant and understanding the patients attitude and feelings

Closed questions:

Gain specific info

Focus the patient

17
Q

What should you not be afraid to ask during the psychiatric history?

A

Do not be afraid to ask about suicidal ideations and self harm.

Essential to the psy hx and risk assessment

18
Q

How could you ask about suicidal ideation/ self harm during the psychiatric history?

A

“How do you feel about the future?”

“Some people when feeling low have thoughts about ending their life. Have you had any thoughts like this”

19
Q

What do you need to ensure you gain during the psychiatric history?

A

Explore thoughts and intent when it comes to self harm/ suicial ideation

Establish any past history of suicide attempts and deliberate self harm

20
Q

What are key components of the past psychiatric history?

A
  • Any current/ previous diagnoses
  • Previous episodes
  • Previous contact with health professionals
  • Previous psychiatric admissions
  • Previous treatment
  • History of deliberate self harm and suicide attempts
21
Q

What are key components of the past medical history?

A
  • Any physical illnesses
  • Previous accidents or head injuries
  • Previous admissions to hospital
22
Q

Key components of the drug history on psy history?

A
  • Prescribed medications
  • OTC medications
  • Allergies
  • Always confirm with the GP
23
Q

What are the key components of the family history during the psychiatric hx?

A

Fam hx:

  • Any history of psychiatric illness?
  • Any history of suicide?
  • Substance or alcohol misuse?
  • History of neurological disorders or relevant physical illness?
  • Quality of relationship between pt and family members?
24
Q

Key components of the social history in the psychiatric hx?

A
  • Marital status?
  • children and dependents?
  • Housing situation
  • Employment?
  • Finanical problems or debt?
  • Social network or support?
  • Religious beliefs
25
Q

What 4 areas of a personal history do you need to explore during psychiatric hx?

A

Infancy and early childhood

Later childhood and adolescence

Occupational history

Psychosexual history

26
Q

What elements of infancy and early childhood should be explored?

A
  • Pregnancy and birth complications
  • neonatal illness
  • developmental milestones
  • childhood illnesses
  • behaviour
27
Q

What elements of later childhood and adolescence should be explored?

A

Childhood family environment

history of abuse (if app)

Education

Bullying

Behaviour

28
Q

What elements of occupational hx should be explored?

A

Jobs

Level of satisfaction

Ambitions

29
Q

What elements of the psychosexual history should be explored?

A

Relationships

First experiences

Orientation

Marriage hx

Domestic violence

Sexual dysfunction / fetishes (if app)

30
Q

What elements of substance/ alc hx should be explored?

A

Evidence of abuse of dependency?

Impact on patients life and relationship between pts problems and drug/ alc abuse

Always ask about cannabis specifically

Think about abuse of prescribed medications (e.g. benzo)

Smoking hx

31
Q

What elements of forensic hx should be explored?

A

Previous contact with the police

nature of offences

convictions and imprisonment

name of probation officer and requirements of probation

Hx of violence?

32
Q

What elements of premorbid personality should be explored?

A

Patient’s personality before the onset of their mental illness

e.g. if we’d met 5 yrs ago what would you have been like?

When you are well how would you describe yourself/ how would others describe you?

Collateral hx

Also explore –> interests/ hobbies/ relationships/ attitudes

33
Q
A